Challenges In Diabetes Care Research Articles

Challenges in Diabetes Care: Can Digital Health Help Address Them?

In Brief There is great enthusiasm for the potential of digital health solutions in medicine and diabetes to address key care challenges: patient and provider burden, lack of data to inform therapeutic decision-making, poor access to care, and costs. However, the field is still in its nascent days; many patients and providers do not currently engage with digital health tools, and for those who do, the burden is still often high. Over time, digital health has excellent potential to collect data more seamlessly, make collected data more useful, and drive better outcomes at lower costs in less time. But there is still much to prove. This review offers key background information on the current state of digital health in diabetes, six of the most promising digital health technologies and services, and the challenges that remain.

An Innovative Approach to Informing Research: Gathering Perspectives on Diabetes Care Challenges From an Online Patient Community.

BackgroundFunding agencies and researchers increasingly recognize the importance of patient stakeholder engagement in research. Despite calls for greater patient engagement, few studies have engaged a broad-based online community of patient stakeholders in the early stages of the research development process.ObjectiveThe objective of our study was to inform a research priority-setting agenda by using a Web-based survey to gather perceptions of important and difficult aspects of diabetes care from patient members of a social networking site-based community.MethodsInvitations to participate in a Web-based survey were sent by email to members of the PatientsLikeMe online diabetes community. The survey asked both quantitative and qualitative questions addressing individuals’ level of difficulty with diabetes care, provider communication, medication management, diet and exercise, and relationships with others. Qualitative responses were analyzed using content analysis.ResultsOf 6219 PatientsLikeMe members with diabetes who were sent survey invitations, 1044 (16.79%) opened the invitation and 320 (5.15% of 6219; 30.65% of 1044) completed the survey within 23 days. Of the 320 respondents, 33 (10.3%) reported having Type 1 diabetes; 107 (33.4%), Type 2 diabetes and taking insulin; and 180 (56.3%), Type 2 diabetes and taking oral agents or controlling their diabetes with lifestyle modifications. Compared to 2005-2010 National Health and Nutrition Examination Survey data for individuals with diabetes, our respondents were younger (mean age 55.8 years, SD 9.9 vs 59.4 years, SE 0.5); less likely to be male (111/320, 34.6% vs 48.4%); and less likely to be a racial or ethnic minority (40/312, 12.8% vs 37.5%). Of 29 potential challenges in diabetes care, 19 were categorized as difficult by 20% or more of respondents. Both quantitative and qualitative results indicated that top patient challenges were lifestyle concerns (diet, physical activity, weight, and stress) and interpersonal concerns (trying not to be a burden to others, getting support from family/friends). In our quantitative analysis, similar concerns were expressed across patient subgroups.ConclusionsLifestyle and interpersonal factors were particularly challenging for our online sample of adults with Type 1 or Type 2 diabetes. Our study demonstrates the innovative use of social networking sites and online communities to gather rapid, meaningful, and relevant patient perspectives that can be used to inform the development of research agendas.

Linking community resources in diabetes care: a role for technology?

Designing and implementing effective lifestyle modification strategies remains one of the great challenges in diabetes care. Historically, programs have focused on individual behavior change with little or no attempt to integrate change within the broader social framework or community context. However, these contextual factors have been shown to be associated with poor diabetes outcomes, particularly in low-income minority populations. Recent evidence suggests that one way to address these disparities is to match patient needs to existing community resources. Not only does this position patients to more quickly adapt behavior in a practical way, but this also refers patients back to their local communities where a support mechanism is in place to sustain healthy behavior. Technology offers a new and promising platform for connecting patients to meaningful resources (also referred to as "assets"). This paper summarizes several noteworthy innovations that use technology as a practical bridge between healthcare and community-based resources that promote diabetes self-care.

Long-term glycemic control by a diabetes case-management program and the challenges of diabetes care in Taiwan

AimsThis study aimed to evaluate the long-term effects on glycemic control of a diabetes care program focusing on case management and to discuss challenges in the quality of diabetes care in Taiwan. MethodsWe randomized 1,060 study subjects recruited from the Diabetes Management through an Integrated Delivery System project in 2003–2005 into intervention (n = 789 from 27 clinics) and control (n = 271 from 7 clinics) groups. The quarterly self-care and nutrition-education program in the intervention group was delivered by case managers, and standard care was provided to the control group. The intervention program was conducted during 2003–2007. A multivariate mixed model analysis was used to assess the 3.5-year intervention effects on glycemic control. ResultsGlycated hemoglobin (HbA1c) level in the intervention group (especially for those with a baseline HbA1c level of 7–9% and >9%) was significantly lower than that in the control group 6 months after recruitment and remained lower through the subsequent three intervention years. ConclusionsThe current findings provide evidence that case management provided in the pay-for-performance (P4P) diabetes care program in Taiwan was effective at improving glycemic control for at least 3 years. However, previous research indicated poverty is associated with not only higher diabetes incidence but also inequality of diabetes care in Taiwan despite universal health coverage. Those with a more severe condition were less likely to be enrolled in the P4P diabetes care program. Additional cost-effectiveness studies and more health policy reforms are needed to optimize diabetes care in Taiwan.

Resistance exercise and control of cerebral blood flow in type 2 diabetes

Keywords Bloodpressure.Cerebralautoregulation.Cerebralcirculation.Exercise.TranscranialDopplerTo the Editor: The challenge in diabetes care is to optimisemetabolic control to slow progression to vascular disease.In individuals with type 2 diabetes this may be achieved atleast in part by behavioural modification including regularphysical activity. In their recent article in Diabetologia,Praet and van Loon [1] comprehensibly and conciselyaddress the need for revision of the current guidelinesregarding the prescription of exercise for individuals withtype 2 diabetes, given the lack of information provided bycurrent exercise programmes on the preferred type andintensity of exercise.The combination of endurance and resistance exercisehas the potential to increase adherence and compliancerates, as it renders programmes more varied [1]. Loss ofskeletal muscle mass is one of the main factors responsiblefor the increase in the incidence of type 2 diabetes with age.Deconditioning (as a result of physical inactivity) andresistance exercise are associated with opposing adapta-tions. Resistance exercise provides better metabolic control[2], mitigates disuse-associated tendon stiffness andincreases skeletal muscle mass, which improves wholebody glucose disposal [3]. Not surprisingly, greater focuson resistance exercise has been recommended for type 2diabetes, specifically for the subgroup of sarcopenic orseverely deconditioned older patients [4].Resistance and endurance exercise have different car-diovascular effects. Resistance-type activities produce aconsiderably larger increase in arterial pressure, because ofthe mechanical compression of blood vessels together withrepeated Valsalva-like manoeuvres [5]. Unlike aerobicexercise, resistance training affects central arterial compli-ance in healthy men [6]. Although acute changes in arterialblood pressure during physiological challenges are trans-mitted to the cerebral circulation, under normal conditions,cerebral blood flow tends to return to its baseline valuewithin a few seconds [7]. Cerebral vasoconstrictionconstantly plays a protective role during exercise ofmoderate to heavy intensity, in particular when pulsepressure exceeds the autoregulatory range [8]. Whenautoregulatory mechanisms are failing or overwhelmed byacute blood pressure upsurges beyond the autoregulatoryrange (e.g. in serious hypertension), brain blood flow

Low Health Numeracy Can Be a Challenge in Diabetes Care

Low Health Numeracy Can Be a Challenge in Diabetes Care

Empowerment: what about the evidence?

The health care system has been very successful in meeting the first set of challenges in diabetes care. As a consequence of this success a new set of challenge, low levels of self-care, poor control and unresolved emotional problems, has emerged to challenge the health care professional. Patient empowerment has been cited as an approach to address these issues. However much of this literature does little to define empowerment, and tends to rely on philosophical rather than empirical argument. This paper defines empowerment as involving at least 5 key features; acceptance, affect, autonomy, alliance and active participation. These concepts are defined, and the pertinent diabetes literature is reviewed. Empirical studies demonstrate a clear association between aspects of empowerment and self-care behaviour. Although intervention studies have tested some aspects of the empowerment model, there is as yet no published empirical study that has tested the empowerment model in its entirety. Until such data emerges the empowerment model, although promising, can only be argued for on philosophical grounds. Copyright © 2000 John Wiley & Sons, Ltd.

Empowerment: what about the evidence?

The health care system has been very successful in meeting the first set of challenges in diabetes care. As a consequence of this success a new set of challenge, low levels of self-care, poor control and unresolved emotional problems, has emerged to challenge the health care professional. Patient empowerment has been cited as an approach to address these issues. However much of this literature does little to define empowerment, and tends to rely on philosophical rather than empirical argument. This paper defines empowerment as involving at least 5 key features; acceptance, affect, autonomy, alliance and active participation. These concepts are defined, and the pertinent diabetes literature is reviewed. Empirical studies demonstrate a clear association between aspects of empowerment and self-care behaviour. Although intervention studies have tested some aspects of the empowerment model, there is as yet no published empirical study that has tested the empowerment model in its entirety. Until such data emerges the empowerment model, although promising, can only be argued for on philosophical grounds. Copyright © 2000 John Wiley & Sons, Ltd.

Empowerment: what about the evidence?

The health care system has been very successful in meeting the first set of challenges in diabetes care. As a consequence of this success a new set of challenge, low levels of self-care, poor control and unresolved emotional problems, has emerged to challenge the health care professional. Patient empowerment has been cited as an approach to address these issues. However much of this literature does little to define empowerment, and tends to rely on philosophical rather than empirical argument. This paper defines empowerment as involving at least 5 key features; acceptance, affect, autonomy, alliance and active participation. These concepts are defined, and the pertinent diabetes literature is reviewed. Empirical studies demonstrate a clear association between aspects of empowerment and self-care behaviour. Although intervention studies have tested some aspects of the empowerment model, there is as yet no published empirical study that has tested the empowerment model in its entirety. Until such data emerges the empowerment model, although promising, can only be argued for on philosophical grounds.